Dipyridamole stress testing

Hillis GS, al-Mohammad A, Jennings KP. Respiratory arrest during dipyridamole stress testing. Postgrad Med J 1997 73(859) 301-2. 

Roach PJ, Magee MA, Freedman SB. Asystole and bracfycardia durii dipyridamole stress testing in patients receiving beta blockers. IntJ Cardiol (1993) 42,92-4. 

A 67-year-old woman with hypertension, who was taking metoprolol 50 mg bd, underwent dipyridamole stress testing, and during the infusion of dipyridamole developed nausea, dizziness, and sudden loss of consciousness. 

The antiplatelet/antithrombotic activity of dipyridamole has been demonstrated in laboratory and in animal models, and has been shown to inhibit platelet aggregation and vessel-wall thrombogenesis [9-11]. Dipyridamole has been given either alone or with aspirin in the management of myocardial infarction and stroke. For the secondary prevention of stroke or transient ischemic attack, the drug may be given as a modified-release preparation in a dose of 200 mg twice daily. Dipyridamole administered intravenously results in a marked coronary vasodilation and is used in stress testing in patients with ischemic heart disease [5]. 

DIPYRIDAMOLE ANTIARRHYTHMICS t effect of adenosine 1 doses needed to terminate supraventricular tachycardias case report of profound bradycardia when adenosine infusion was given for myocardial stress testing Dipyridamole inhibits adenosine uptake into cells l bolus doses of adenosine by up to fourfold when administering it to treat supraventricular tachycardias. Some recommend avoiding adenosine for patients taking dipyridamole. Advise patients to stop dipyridamole for 24 hours before using adenosine infusions... 

Digital subtraction angiography Dipyridamole-thallium scan Dobutamine stress test Doppler studies Echocardiography Electrocardiography Electrophysiologic study Fibrinogen... 

Dipyridamole reduces the bolus dose of adenosine necessary to convert supraventricular tachycardia to sinus rhythm by about fourfold. Profound bradycardia occurred in one patient taking dipyridamole when an adenosine infusion was given for myocardial stress testing. 

Adverse interactions occurred in another 2 patients taking beta blockers during diagnostic dipyridamole-thallium stress testing. One patient, who was taking atenolol, developed bradycardia then asystole, which was treated with aminophylline and atropine, and the other patient, who was taking metoprolol, developed bradycardia, which resolved after she was given aminophylline. ... 

Cardiovascular Takotsubo cardiomyopathy has been reported in an elderly woman who underwent pharmacological stress myocardial perfusion imaging with dipyridamole [55 ]. All abnormalities resolved completely 1 month after the initial stress test. 

Miner R. Factors influencing non-cardiac side-effects of dipyridamole when used for myocardial perfusion stress testing. J Med Imag Rad Sci 2012 42(1) 43-51. 

The incidence of major adverse reactions to dipyridamole was determined in a multicenter retrospective study, involving 73 806 patients who underwent intravenous dipjridamole stress imaging in 59 hospitals and 19 countries (4). The main conclusion was that the risk of serious dipjridamole-induced adverse effects is very low, a conclusion that is in line with other reports (5), and comparable to that reported for exercise testing in a similar patient population. Combined major adverse events among the entire patient population included 7 cardiac deaths (0.95 per 10000), 13 non-fatal myocardial infarctions (1.76 per 10000), 6 non-fatal sustained ventricular dysrhythmias (0.81 per 10000) (ventricular tachycardia in 2 and ventricular fibrillation in 4), 9 transient cerebral ischemic attacks (1.22 per 10000), 1 stroke, and 9 severe cases of bronch-ospasm (1.22 per 10000). Minor non-cardiac adverse effects were less frequent among the elderly and more frequent in women and patients taking maintenance aspirin. 

Beleshn BD, Ostojic M, Stepanovic J, et al. Stress echocardiography in the detection of myocardial ischemia Head to toe comparison of exercise, dobutamine, and dipyridamole test. Circulation 1994 90 1168—1176. 

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